VERTICAL GASTROPLASTY WITH ARTIFICIAL PSEUDOPYLORUS - A MODIFICATION IN THE TREATMENT OF MORBID-OBESITY - EARLY RESULTS

A new technique of vertical gastroplasty was applied in 50 morbidly ob ese patients. Eight of them were male and 42 female with a mean age of 34 years (range 20-58). The mean excess body weight was 77 kg (range 52-133) and the mean Body Mass Index 51 kg/m(2) (range 42-81). Under d irect vision the hepatogastric and gastrophrenic ligaments were divide d and two TA-90 double-row staplers were passed together through the l esser sac vertically downwards from His angle parallel to the lesser c urvature of the stomach. An additional TA-90 stapler was applied betwe en the two double rows. The pseudopylorus was constructed 3-4 cm below the stomach angle by the use of two bands of silk No. 0 which were co vered by stomach serosa, thus creating a reinforced outlet having the shape of a pylorus which we called 'artificial pseudopylorus'. The cir cumference of pseudopylorus was 4.8 cm and the total volume of the ver tical pouch of stomach 15-20 ml. The percentage excess weight loss on the 3rd, 6th, 12th, 18th and 24th month postoperatively was 35, 51, 68 , 80, and 82 respectively. One patient died 12 days after operation. O ne other patient was re-operated because of staple-line breakdown and acute abdomen formation. It is concluded that vertical gastroplasty wi th artificial pseudopylorus is a simple and safe method that avoids co mplications of other forms of gastroplasty, and is of value in the tre atment of morbidly obese patients.